HomeMy WebLinkAboutHENKINS BLK 1 LT 4n ki,* n s Block 1 Lot A #051-292-22 �00CPALIr.O,. MUNICIPALITY OF ANCHORAGE Rent , ' 7 On-Site Water&Wastewater Program ..,,oSo f \, PO Box 196650 4700 Elmore Road • i Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpa/www.muni.org/onsite C ,. ,,,,) 1)( l),11:1ni, nt 9'1'CN0RPGF' On-Site Wastewater Disposal System Permit Permit Number: OSP181380 Effective Date: 11/5/2018 Work Type: Septic Upgrade Expiration Date: 11/5/2019 Tax Code Number: 05129222000 Site Legal Address: HENKINS BLK 1 LT 4 G:0755 Site Mailing Address: 16207 OLD GLENN HWY, Chugiak Owner: JONES BRIAN N & MEGHAN E Lot Size in Sq Ft: 21344 Design Engineer: PETER A. STANLEY Total Bedrooms: 3 This permit is for the construction of: El Disposal Field ❑ Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. The location of the 1968 crib is unknown. If, during construction, the crib is located, construction of the system will stop and a design change submitted to On-Site for review and approval. 2. All ML soil to be removed. MOA approved filter sand to be used to level prior to the 2' sand filter. //1 Received By: / Date: / / Issued By: 1`r"" a , / / — *NW /// ./9 MUNICIPALITY OF ANCHORAGE ' \ , f � r7 Development Services Department Phone: 907-343-7904 On-Site Water &Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-292-22-000 jj Property owner(s) JONES BRIAN N & MEGHAN E Day phon�N�l) C( ll —bj() Mailing address 16207 OLD GLENN HIGHWAY, CHUGIAK, AK 99567 Site address 16207 OLD GLENN HIGHWAY, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) HENKINS, BLOCK 1, LOT 4 Legal description (Township, Range&Section) 30, 15N, 1W Lot Size 21,334 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (El all that apply) Absorption Field 0 Initial ❑ Single Family (SF) E (w/wo ADU) Septic Tank ❑ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Field Orientation (15.65.21 OE_1.b) Distance: !'1At I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. J Y (Signature of properI o ner or authorized a4ent�:, T�,• ltr;.r (v ("ter •k"1''s J Permit/Rush Fees: 5'D .00 Waiver Fees: ( 55.00 Si'Date of Payment: • Date of Payment: D I 11 Receipt Number: 1I Receipt Number: 6)..-703 Permit No. OS jjgi 2 2 SD Waiver No. 05V igloo G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Peter A. Stahley, P.E. and PMP Civil Engineer 10/31/2018 Municipality of Anchorage Development Services Department—Onsite Water& Wastewater 4700 Elmoore Street Anchorage,AK 99519 Subject: Henkins Subdivision, Block 1, Lot 4—Request For Replacement Drain Field Permit & Waiver to 15.65.210E.1.b "Disposal Field Orientation"; Revised Narrative (Original Dated 10/19/18) The purpose of this letter is to request a permit for the construction of a replacement absorption field for the subject property. The lot is developed and contains an existing three-bedroom dwelling, currently served by a 1000 gallon septic tank, deep trench drainfield. The drainfield is showing signs of failure, with reduced absorption rates and periodic backups. The septic tank has been inspected from the surface and does not appear to have settled or caused issues with existing conveyance pipe to/from the existing deep trench or residence. 1. Existing Conditions:The lot is served by the failing absorption field, installed in 1980, and a septic tank installed in 2011. The lot is served by a private well, as are the adjacent lots. 2. Site Topography:The site is fairly flat, with minimal slope north to south, and limited slope with a maximum of^3 to 5%from the back of the lot to the front. 3. Proposed Replacement: a. Sizing: The proposed replacement absorption field is a bed system, with minimum dimensions of 42.86' long at a 15' width. System sizing is based upon the use of a 2' filter layer of sand and an absorption rate of 0.7 GPD/SF. The percolation test performed on 10/17/2018 showing a perc rate of 13.71 minutes/inch was limited to a relatively thin ML layer, with a free draining gravel layer encountered below. A filter sand system was chosen because deeper system types are constrained by the GW layer while the starting invert is controlled by the existing septic tank which limits the amount of useable existing native material available.Note: All measurements were made to the nearest 1/16", although written in simplified form (i.e. 8 %2" is written, instead of 8-8/16") b. Design Calculations: 3 bedroom x 150 GPD=450 GPD; Filter Sand->0.7 GPD/SQ FT 15870 S.BIRCHWOOD LOOP ROAD,CHUGIAK AK 'f(201)931-6002 l:PSTAHLEY@GMAIL.COM Disposal Area = 642.86 Sq. Ft. required; 642.86 SF/15'wide=42.86 LF Use 43'(L)x 15'(W) Bed with 2'(D) Filter Sand layer. Invert at 520.45 to allow ample gravity flow from septic and maintain separation to deeper ML layer seeps. The reference elevation is called out as 524.5 on a concrete slab, and all elevations are tied to this—see Sheet Cl. c. Siting & Slopes:The replacement site is located parallel to the existing field and outside the 10' of clearance required based on twice the existing systems effective depth (which is 5'). No steep slopes are located nearby. d. Field Orientation (WAIVER REQUESTED:) Note that due to site constraints (existing field, trees, property lines, etc) the field is perpendicular to the contours of the site, resulting in a drop of approximately 3' over the length of the field. Based on the 38 year operational history of the existing field which operates in a parallel orientation and review of site conditions, this siting will not negatively impact the performance of the new field. This waiver would not negatively affect adjoining properties and would allow replacement of the failing field in the originally designated location without excessive vegetation clearing due to trees and vegetation in the northeast portion of the site. Boring logs in the vicinity are consistent and indicate soil conditions are not expected to change even as grade falls away. The profile below shows the design elevation of the bed versus existing grade, the ML layer, and seeps observed during the test hole process. Lo°t s.Jcc {;<0 elcu on Ews+,Aa 6rv. �•g ate' Wcf.l cK,Q e"`" • a'SAVO LAVER _. b071.14 cF Slq.615, 4 .5AftD.TO Si 4 S' Lir 0"41 r 64 11'07, seers , !� Elcw�io� 518.44 •LI6 Lfetl St34 (5. .6 9(-0.1J�, cam:+ -to ..s+) Gruphk- ScAI C a 4 8 16 ati Figure: Profile of proposed system,scale as noted 4. Groundwater: No groundwater was encountered down to 18' below grade. Well and drilling logs indicate groundwater is located 50'+ below surface. 5. Wells & Water Systems: No private wells are within 100' of the existing or newly proposed absorption field. Similarly, the public water well on Lot 1A of the Henkins subdivision is well outside the 200' of clearance required. 6. Surface Water & Drainage: There is no surface water within 100 feet of the proposed or existing systems. Drainage will not impact the operation of the proposed system. This proposed replacement system will not affect the future development of the surrounding or existing lots. Should you have any questions or concerns, please contact me at 201-931-6002. Sincerely, % ° • 49TH �\ • *4 • 49 p • PETER A.ST / Or` , • No.CE-103095 •��,-• Peter A Stahley, P.E. & PMP 1l>>>�FES Civil Engineer Attachments: Drawing Package (3 Sheets; Existing Conditions, Replacement Site Plan, Details) Soils Log & Percolation Test Results 01 -0 _ - LHn \e fls G \ L 1 -_-_- cc \ Existing • General Notes \ NO ; System Elevations and Inverts 1. Field Conditions have M - M POINT SURF ELEV INVERT been determined by I k Slab-SE Corner 524.5(Benchmark) n/a on-site review, CO \, \ Bldg Clean Out 524.25 522.16 existingy � g survey/as-built O documentation, and Septic Inlet 525.19 521.09 On-Site* 41 Muni N 3 Septic Outlet 525.57 520.93 and Wastewater Water I \ Post-Septic CO 526.16 520.92 documentation. Locations may be Monitor Tube 528.46 520.83 approximate UON. 4. 2. Existing Dwelling is 3 e I bedroom, requiring Li ( E) 4111ie n k i n s 3 B l o c k 1 t 450 GPD disposal site. (Y 3. Site is generally flat, D ; *- north to south, with limited slope from rear of lot to front. 3 4. Existing Deep Trench I field is at 9.1' BG Existing Concrete Slab. \ per records and SE corner used as reference benchmark, monitoring tube. at assumed elevation 524.5. 5. No groundwater Inverts/elevations relative to this point. k' observed. 6. Percolation observed O 0 Vit' 1��\\\\ at 13.71 MPI. 1c ( ) * W �� ell E `� w�F�L A S >I` � 7. SE Corner of exterior ,; • ''1 ' i slab at garage used ��: i As. . t, as local benchmark, ���. . �N �� �r elevation 524.50'. k • w�~_ w - -n k' s B I o C 1 Lot 4 il fairr mar u j to X11 �RrP�o 5. iW rbc* ::En O• •1.11r00 MIca ESsti \ y129 . 40 ... M M r- / \A QS `. • _ � —F� • / 10.]1.16 3 1 ' m t Gomm«G- plt.w9..1.latlon/FiMrt Y�fo 10'x10', - s ge _ . Approximate locations of abandoned see•a•e •it Pe and septic tank per 1968 Health Authority Inspection report. ‘N° Revision/Lew Data, •11Location based on swing ties from building and abandoned well. _ No visible remnants as of 10/2018 review of site conditions. �\ �� P res.. - � S 5 Rr 30' Perc ' Peter A Stahley PE+PMP \ / Ch BOX Perc Test Test Radius 1 0 0 Yi .5' •BGr Chugiak AK 99567 ^ Perc Test W---.....____________ W W II I I -e •I. (NOT USE, . (I) with dual cleanouts 41 kit ..I C *- ,....P..Ing..._ 0 Deep Trench JONES - Replacement Dram Feld :47, 16207 Old Glenn Hwy - M M e Drain Field (E) Chuglak < -' ;,ns dock 1 Lot 57 aaska C / Groundwater Monitoring CD — CD 5 tains no wells orTube F 4/ (to 18' BG) 01 septics Jones — Existing .r C I Lots t s 5 a n d u s e d a s10'28'2018 C 1 +, 0 40 80Lel ( E -- •X I • � •ngle property\ — — - E �°' Feet Lel o Hens SII` 1 Let 4 ; Henkirt�� Blo 1 System Elevations and Inverts General Not.. ` �I \� - . POINT SURF ELEV INVERT 1. BASIS OF DRAINFIELD 00 Slab-SE Corner 524.5(Benchmark) n/a DESIGN IS 13.71 MPI 11 Bldg Clean Out 524.25 522.16 SOIL, CONSISTING OF SILTY SAND (ML) AT N Septic Inlet 525.19 521.09 5'-8.5' BG, 9 Septic Outlet 525.57 520.93 REPLACED WITH itFILTER SAND TO Replacement Field 528.8 526(varies) 520.45 REDUCE FIELD FOOTPRINT. - . 2. NEW FIELD IS BED CL Existing Concrete Slab. TYPE, 43' MINIMUM SE corner used as reference benchmark,7/ LENGTH, 1 . WIDTH. at assumed elevation 524.5. 3. MAINTAIN MINIMUM CLEARANCE OF 10' LJJ Inverts/elevations relative to this point. w FROMEXISTING Z _ 4. CONNECT TO J +� J EXISTING SEPTIC -4.00 USING "BULL RUN" -Absorption Field Basis of Design: 13.71 mpi soil replaced with filtejisa''‘ _\‘'--- • \� " DIVERTER VALVE AND N 450 GPD (3 Bedroom) C4 0.7 GPD/Sq. Ft (Filter Sand) OF . . As�gl CLEANOUT ASSEMBLY U00 450 GPD/0.7 = 642.85 Sq. Ft Required �, • , 5. PROVIDE CLEANOUTS *s.:' AT EACH END OF Use 43'(L) x 15' (W) Bed Absorption Field • •�i NEW DRAIN FIELD. 4 6. PROVIDE MONITOR �, % ,k`• �,/��, O TUBE IN DRAIN FIELD /, w ,, PER AMC r' �PH�E� • �, 15.65DRAIN.6 / 11 00 P.S 95 0"0 7. MAINTAIN !EL BED DRANFIELD, 15'x45 $ 'sr �� , �'\ . , Hnkins �OCk LOt q 3 PIP ® 5C , 8. SEEHEASHEET 3 _.'j '��� DETAILS. AT ELEV 520.45 'W/ FILTER SAND 9. SEPTIC OUTLET ppSEE DETAIL 2/C3 ELEVATION 520.93, FIELD VERIFY (,-4.75' BG) `... 4-411 • -49 I -I • 0 Ve•etated ,�•� Areas O� '\` 1 .P.rmR Comments— 10.31.1E . . �-• i / O ♦�10'x10. Seepage' • / —.,� •�: \`' \Mo. Revision/Issue Date, A••roximate locations of abandoned see•a•e •it -it @• tank per 1968 Health Authority Inspection report. xi ti ,sa % 4" MONETOR Peter a tahley PE+PMP ed on swing ties from building and abandoned well. -ptic Taf. TUBE. PO BOX z - Sheet Note ` Chugiak AK 99567 remnants as of 10/2018 review of site conditions. �� --' ` - •' Per Perc Tet 12' Test '•dius rhynt Nom ad Mama i OR E L) -4111117/ PROPS'TY L E) JONES — Reii ‘ placement Drain Fel AK �/ _ W A 16207 Old Glenn Hwy 1111 ChuAl _ . _ DOUG E CLEANOUT I \NEW I,ti� O= Alaska k SEE DET IL C3 �. Z , _ XISTI ,,,. U -..:.. D R A T I E LD NEw syEten, site plan M - M 40 " TO MAI "10/28/2018 C 2 C3 N a � IW— - s :I -et � '• = 20 J N >,— //----- IY (n (n -0 i DO Vi t 1(t�a I lit Yr Material Specificationsper Henk\115 i k L+ 9, 4" TOPSOIL \ N -F /% /� I'�/ 'WATER-TiOHT p --. AND SEEDING _ General Note. 0 � /; ACCESS CAP AMC 15.65 and Notes, / ��/./.I./. , ,././.; �. r • �/ `��`�/I�/I/!\`�/`�/��\ �`%,$Q�j`�:' 1. Field Conditions RISER c,� 1 . All pipe t0 be 4 I.D. ////N.-A� „,,� ,�, , „NAS• -/t##- N. / have been ADAPTER 2. Cleanouts and Monitor determined by CO RISER / on—site review and TUBE Tubes require / existing 0 VALVE DIRECTION watertight cap 9 PIPE BEDDING, NFS survey/as-built N "ArDLE 3. Leach Field Selection BACKFILL WITH documentation. ?? rOUTPORr „ 2. Site is generally Valve to be BULL NATIVE MATERIAL flat, north to r otrrPORr �� PIPE ELEVATION PER PLAN south, fromn rear limited �� RUN" or equal. �,�� �,'� : lot to front. ' -'-'..' .- '4'1119' • , ..;too a••airkato•{iv 2" MIN / 3. Existing Deep Q r IN PORT 414, -404(0.4• Z 0 Trench field is at • toe O Z 9.1' BG per records I� � • fV � and monitoring LL_I 3 ., LL U \ VALVE 'Mit. ,��S ��. 4" PVC PIPE E tube. '•i ll• ifilkt ' CL m 4 observed.No groundwater C3 NOT TO SCALE ! i �• ���••� „ 5. Percolation �'I_•'�IL� �• �_I•i��I•. 4 MIN observed at 13.71 MOUND 6" MINIMUM / I ; ,i MPI, Replace with ABOVE ADJACENT // / filter sand.. 0 GRADE, REMOVE AND REPLACE 6. Installation shall be PROVIDE 4" MINIMUM UNSUITABLE MATERIAL, in accordance with TOPSOIL THEN SEED. Muni Code 15.65, COMPACT/PROOF ROLL Part I and Part II. -- 6" — --_ 6" 7. All material and -11=11=11.„ „11-11-11..-11.-11.,-,.11,,. _,;.111-,.IL-11,,-.11,-,.1111-,.111-,.11-,.111-,.111-,.II„-.11,-,.11„-.IL-,.11,-,.11.,-,.11.,-,.11.,-,_ - components shall 1'=11-11.=11=11=[-i=II=11=11=II=1I=11=i= =11=11=11=11=11=11=11.=11=11=11=11-11=11-11-11=11=11-11: : be in accordance 11=II=11=II=II=II=11=11 11. .11 11-11-11-11-11-11-11-II-I1-11-11-11-1I-I1-11-I1-1I-II-11-11=1I=II-11 with Municipality of -11711-11-171711711711711-11-11-11-11-111-11-11-11-11-1111-11-11-11-11-11-11-11-11-11711-11-11' BACKFILL WITH CLEAN 1 S EW E P I E DETAIL Anchorage On-Site CO NATIVE MATERIAL, Water & Wastewater U' • OF C3 FIELD SEPTIC TO FIELD, NTS Program O 15' BED WIDTH COVER, 2' ALLOWABLE "Standards and WITH INSULATION Specifications for REQUIRED Component Parts and Materials” - 1'r) NATIVE MATERIAL, February 2011. \ _ SCARIFY IF 0 SMEARED DURING 5' O.C. Perforated 2.5' to N— CONSTRUCTION Distribution Pipes edge of field 2" MIN ABOVE "�O� ALAS'�\\A I Chat*to Bed /F1t Satd 10.31.,9 4 11 .�/••'' •.OW( •.'' •.,' ••I' �.''_=.,'_=.,'_=.I'_` _=,'' .,' ,'' ,- ; , �P,G• • • • ,-- • -4, `NoRevision/haw Mei a, a, a, a, a, a, a, a, ` a, a' a, rA. 1 •)'�'�'� '�'�'�r ' ' ' �'�'�' / 4" PERF PIPE j '!N �f1/4 • �, 1 1 11 1 1 .4•44•44.14.•. 1 ` lr1 1 1 1 ► 1' �' �' rinvert elev. 520.45 / Arm Mom obi Maws Peter A Stapley PE+PMP Up a a a t a a . a a a /'s'o s .: ;•;'; .;. •;A: --I��of :�sly * Ii e 'cc/ P O BOX I, / 6- SEWER GRAVEL �—� %o Chugiak AK 99567 t, t, t1 tAt t, ., t tAt t1 tiktA ttit / t/ ♦,r , BELOW PIPE • a •a •a a a a a a a a a a a a a a a a 1 Q D N D N N D D N N N N N N N 1r ' CO3/o95•kir W /N N N N N N N N N N N N N N FILTER SAND +its/. SO it ()§,,i. 0 Z C. C. C. C. I> C. C. C. C. N N N N N N N N N N 2' MINIMUM \`RfD FROFE S "°""'.i""' N N N N N N N N N N N N _ i �"NN�� 16207 - Replace eennt Drain Fie! Z N NN NN NN NN NN NN NN NN NN NN NN -› NN Hwy Chugiakld 0 D N N N N N N N N N N N N N Alaska N „ N N N N „ N „ N „ N „ N „ N „ N „ N N I i/�%ii/�%i iii iA e.. Cr_. Jones - Existing cn i2 A3SOPTIO \ FIELD — 3ED TYPE — SECTION A\ D PROFILE _ 10 ,31,18 , C3 z . As Noted O \ \C3 NOT TO SCALE OF AL4 ,,`11 Municipality of Anchorage �P. NGINEER'S )]1 • • Development Services Department .0 • `�� • rr Building Safety Division * 4 4 9TH �� .* f! • . 7 y.r On-Site Water and Wastewater Program I , 4700 Elmore Road /- •- : 0 / P.O.Box 196650 Anchorage,AK 99507 / �-1 4�. / www.ci.anchoraae.ak.us / /� ' �' (907)343-7904 t � • . PET R ..STAHLEYv7F r �'�S, • No. CE-103095 +`(` : Soils Log - Percolation Test �R • . . •• •� i •F �_� 1lFap OF^S \C'-7- Performed For: H t Ctla e ( •3 ovi r'.s Date Performed: f�} 1G)//• Legal Description: /lei)kin S gab, .�` zo f Township,Range,Section: 301 K iJ l,V ./ , Slope 'Site Plan 1,[ e c• cff. 4,y) `Depth IrrSFeet) -_e, Tc So;I4' 1-�` . 7gxed070.01'6 2- GGA wtll- ,:<utcicp."I/ a + � aft4c 4. , \c, � �)y �4- .f.- G w/ �: v �„N O'iii....-_____i ICS il'i Wil. fnSGnd, �QV�t= ! - 41I11r ltfill (O Abra✓YjcSfi i3 ;t17- ^ m 6 e,651:,- c'cQd 608- +, Tcs4 � WAS GROUND WATER A / d of C0 44 9- rOArSe4' ,/l ENCOUNTERED? /V�L� S� �T�� Willi ��� 1s ' S� _' ' j r ��' �; �t -/SG�t IF YES,AT WHAT DEPTH? �� /G.` 05 jy (- (7V1 Depth to Water After / 1</ Q�? Monitoring? MAC E i.'- 11- 12- :.V 6/Afti Date: 10/l.7./... .4 5 0 t(°S. L LAI Ql.k�14461')13- i� tii,_ Sunr�6,,,d F-'1! 14 . a+w Reading Date Gross Time Net Time''"•1 Depth to Water Net Drop or $ii-stif i 15- . ,1 .4 t-dz t SivA- (0/I 0 3' (IS" 0 ,....4.,16 I ML i S.6tAcLs-S;14" %r LI t 15 r'+'' 4 30 10 "(re) 6l`t, ,y • 17- ' 1 i; CH- 5 i0 LP-Ad, ). If U+ PC't t6� ': '" ti 0i to "[ 18 wt �j 3 S...3�.P"' f IC. ?-'' 3�� e1ke)(,7 19- l Li 'r c plti 4 - y /' // ie vsLxi. m�riv.ti G� �6 /Lit �: f} .S PM 20- It me-11,0c, 3 6r6 I//, & its t r -9•:O61.+1 1:.01 6 vti , , yii PERCOLATION RATE I Z, ?-I (minutes/inch) PERC HOLE DIAMETER G f�- .7 ', (0/*AS TEST RUN BETWEEN �� C� FT AND FT COMMENTS T / n `, / � Test ,) ‘,.icu run (J� C�'.S -�� 10 t?. �•. (r,•nf;,.��U r��ii i.. . ("cr.(�.ti`; te't^',: ,, 1-;i.flair (writ vr,tln^ a Ors/ tigx((t-+r ihct'orb-:,, /lea PERFORMED BY: F frc' A , S -al,1t, 'c, 1 t ! ,e CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE ANLMUNICIPAL GUIDELINES IN EFFECt,OP HIS DATE. DATE: (`)/l�� .)L:�(�% l e Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 2 www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW111126 PID Number: 051-. ;k- �- Name: Wastewater System: ❑ New ® Upgrade Atltlress: ABSORPTION FIELD Phone:-8720 Number of Betlrooms: D Deep Trench ❑ Shallow Trench ❑ Bed 0 Mound D Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: Block Lot: Subdivision: Depth to pipe bottom from original pace: Gravel depth beneath pipe: Henkins Ft t. Township: Range: Section: Fill added above original grade: Gravel Length: Ft. Ft. Well: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between Imes: Ft. Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Exisfig Private Ft. FL Fe 1 3034 Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. Flintstone Const 1 7/29/2011 Yield J Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublicJPrivate Manufacturer: Capacity. From Tank Field Station Tank Seveer Line Anchors a Tank 1000 Gel. Well 129.4 --- --- --- Material: Number of Compartments: Steel 2 Surfaceweter 100+ LIFT STATION 11 Size: Manufacturer. Lot Line Gal. Foundation 73 'Pump on' level at 'Pump ofr level at High water alar at: in. in. in. Curtain Drain 50+ 7 Pump Make & Model Electrical Inspections performed! by: Ramarka: Existin tank removed and disposed of per code. BENCH MARK Location and Description: House FF Assumed Elevation: 100.0 Ft. Engineer's Stamp •• OF q '� Inspections performed by: PES. LLC Dates: 1x'7/29/2011 TH 49— 2n07129/2011 .....7. .... .........d.....� A Development Services Department approval P P PP ' j. ;Steven R. Pannone Ar Conditional Approval by: Date: ��j�♦.,N��bIB 149 's' / Reviewed and approved by: Date: I - l a- / �44FESS,�6k et, —'M — Al ss T1 w_— W—� W 5 DC �M �M LOT UNDEVELOPED NO WELLS OR \SEPTICS 2/\ WELL (E) NOTES: RECORD DRAWING PLAN / �W�_W EXISTING SEPTIC AREA 1000g SEPTIC TANK: (P) EXISTING AND DOUBLE CLEAN O�M SEPTIC AREA COLLAPSED I OOOg SEPTIC TANK (E) ABANDON PER CODE DRAIN FIELD (E) 16 �MT WELL (E) SWING TIES CO A B FC 27.8 12.3 Cl .0.0 94.0 7.0.0- TT wa T1 T 96.9 73.1 T2 102.0 78.7 'z DC 108.5 85.6 3 CO T2 B �\ MT 4 . 12 .7 � W / �W�_W EXISTING SEPTIC AREA 1000g SEPTIC TANK: (P) EXISTING AND DOUBLE CLEAN O�M SEPTIC AREA COLLAPSED I OOOg SEPTIC TANK (E) ABANDON PER CODE DRAIN FIELD (E) 16 �MT WELL (E) PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 HENKINS, BLOCK 1, LOT 4 JENNIFER STINER P.O. BOX 772633 EAGLE RIVER, AK 99577 P HLA nth 10/17/11 49RI /rPE�RMIT =50- NO /2-22 Leven f ennorie � N0. CE 8149 : R � ,,,, v 1 OF 1 o s 5 0 o TT wa 5 3 102.4n Inn till � W 96.8 10008 SEPTIC 96,6 TANK (N) PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 HENKINS, BLOCK 1, LOT 4 JENNIFER STINER P.O. BOX 772633 EAGLE RIVER, AK 99577 P HLA nth 10/17/11 49RI /rPE�RMIT =50- NO /2-22 Leven f ennorie � N0. CE 8149 : R � ,,,, v 1 OF 1 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE rr Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111126 Tax Code Number: 05129222000 Work Type: Septic Upgrade Permit Effective Dates: June 27, 2011 to June 26, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: HENKINS Site Legal Address: HENKINS BILK 1 LT 4 G:0755 Owner/Address: STINER JENNIFER E PO BOX 772633 EAGLE RIVER AK 995772633 ent S 1:. epaj tjai ent Site Mailing Address: 16207 OLD GLENN HWY, Chugiak Lot Size in Sq Ft: 21344 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. �L. Received By: r' " Issued By: Date: is 127111 MUNICIPALITY OF Community Development Department DevelODIleft Services DMsion On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0G_/-ZqZ--ZZ_ Naimoli-= Property owner(s) -,TCA1NiF6jr, s-rj*ER Day phone Mailing address F'0. Site address I (*-zq7 6,-0 6_L.,--1vA) 14tj Legal description (Sub'd., Block& Lot) BL -&l 4-&Tq Legal description (Township, Range & Section) Lot Size _Z 341q —Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (S all that apply) Absorption Field F Initial El Septic Tank 9- Upgrade Holding Tank El Renewal ❑ Privy 0 Private Well R Water Storage El THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Sign property owner or authorized agent) Permit/RushFees:,_-'k— -5—ateof Payment: Receipt Number: Permit No. C:6e Waiver Fees: Date of Payment: Receipt Number: Waiver No. GABui1ding\0n SiteTorms\Client FormsTermit App_01 041 1.doc (Rev. 1/11) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panensak.com June 21, 2011 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Henkins S/D, Block 1, Lot 4 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The existing steel 1000 gallon tank is collapsed. The damaged tank is exposing the raw sewage to the environment. The existing tank will be abandoned per code. The clean out at the end of the existing drain field is separated and will be repaired. The surrounding lots are served by private wells, and there are no wells within 100 feet of the proposed septic tank. This lot is served by public water as well. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 4 slopes from west to east at approximately 2% in the area of the tank replacement. The proposed installation will be located in the southern portion of the lot next to the existing septic tank and absorption system. Milling: P,O, Boy: 1.00217, Anchorage, AK 99510 02 17 M. P,hys<caL 61.5 Easy 82" Ave, C Ljite B6, Anchorage, AIS 99503 Telephone: (9 07) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: 0ailing� P,O, Box 1.002.1.7, Anchorage, AK, 99510 021.7 Physical: 615 East. 82",:; Ave, Cuite B6, Anchorage, AK, 99503 Telephone: (907) 272-821.8 FAX: (907) 272-821.1 WELL (E) Cb _—AA 1 M WELL (E) \ \� \ � 1 WELL (E) D/W \ W W—_ w EXISTING \l� /1 .IIA SEPTIC AREA I w�— w-�w�ss w— vv �v��� w� LOT UNDEVELOPED M NO WELLS OR WELL (E) \/SEPTICS a L o G z U N / / 1000g SEPTIC TANK (P) \ / AND DOUBLE CLEAN OUT M EXISTING i / SEPTIC AREA Ss COLLAPSED 1000g SEPTIC TANK (E) ABANDON PER CODE 16 DRAIN FIELD (E) 4\5 W NOTES: PAMONE ENG SVC, C UIC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _+SOF q \` i '�� `'9slll �- • 1N #,�r * .... .. .... , • , Steven R. annone (r �F . CE 8149 j cs�, Aw ,,ll`��1�?OFESSIONP� Date 6/21/11 EMERGENCY REPLACEMENT Scale 1"=50, HENKINS, BLOCK 1, LOT 4 JENNIFER STINER P.O. BOX 772633 EAGLE RIVER, AK 99577 P.I.D. NO 051-292-22 PERMIT NO. XXXXXXXXX PLAN Sheet 1 OF 1 MUNICIPALITY OF ANCHORAGE �e_ nrr— �—Piw /o-' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION V ,-E77J64TTJ ENVIRONMENTAL ENGINEERING DIVISION ���tJl�-[ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME p /���J} 1 9/ AOI Y r / #-��t✓�� LIIL�� /LI �-� PHONE (TJ�� �ZJ� ❑NEW 1PGRADE MAILING ADDRESSOf3a a � pp &X. �LIVG LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS nl' �� ,4��f-c If, P,�g 3 C7 DISTANCE TO: Well f !�' Absorption area :7 Dwell in If PERMIT ,(4o. 7 Y w Q Manufacturer /J �A Material No. of co�]artments G N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6 Y JUz DISTANCE TO: Well t �L.s Dwelling r� PERMIT NO. = Z H Manufacturer Material Liquid capacity in gallons O -�M w DISTANCE TO: Well Foundatio / Nearest lot ling PER IT NO. /40 J LL Z Z w I'—OC No. of lines l Length of a ch 'ne Total length of Innes / Trench wid inches Distance between Ines ¢ F Top of tile to finish grade Material beneath tile Total effeQ�ive absor tion area �/O 0 &0 �v inches Length Width Depth PERMIT NO. Lu 0 aF Type of crib Crib diameter Crib depth Total effective absorption area Wa WWell to Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE N�A-10 _190eI-�A_Leo ze SOI L TEST RATING / INSTALLER REMARKS 9 1r. F o APPRO DATE LEGAL \ 4/ l TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT; BR>= 136 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C-4 HE F=�-r " -1 1 -0 1 F7 V-4 s:3 -r " 4- -1 13FRIzlVal C-- F= F�-F- THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F, E= 479 U I F-:: FEE r,- _F. FE F=� -r 3: 0- -r F:l V-4 t--: S 17E= (D C-5 ID 0n9_1_ 0 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCE'S, THAT THE WELL WILL SERVE. --- -rWI7-u < :2 > F=IF,"E: F,:E:C-!UlFR. aE:o — — — BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM is 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=oE-=F;l'Ml-r 0,E:lZE"ME-E-14Z 2:1, -1 ID I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. M. 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:-- ---------------- APPLICANT H OLD JURGUNSEN ISSUED BY ------ -DATE- y 1-d V4.0 "U"IC:,�lFo'ni I -FV OF= n"C-U-�QF--Fl0F= DEPARTMENT i' , HEALTH AND ENVIRONMENTAL' �OTECTION 825 'L' STREET, ANCHORAGE, AK 99501 264-4720 1 -FF= FE LJ FEE F;'.' Fzo r=- F2.M I _r PERMIT NO. '80016-7 ) APPLICANT HAROLD JURGUNSEN PO BOX 1282 E. R. 99577 688-2385 LOCATION LEGAL L4 B1 HENKINS S/D LOT SIZE 20800 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT; BR>= 136 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C-4 HE F=�-r " -1 1 -0 1 F7 V-4 s:3 -r " 4- -1 13FRIzlVal C-- F= F�-F- THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F, E= 479 U I F-:: FEE r,- _F. FE F=� -r 3: 0- -r F:l V-4 t--: S 17E= (D C-5 ID 0n9_1_ 0 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCE'S, THAT THE WELL WILL SERVE. --- -rWI7-u < :2 > F=IF,"E: F,:E:C-!UlFR. aE:o — — — BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM is 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=oE-=F;l'Ml-r 0,E:lZE"ME-E-14Z 2:1, -1 ID I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. M. 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:-- ---------------- APPLICANT H OLD JURGUNSEN ISSUED BY ------ -DATE- y 1-d V4.0 r O & E ENG114EERING & DEVELOF ovIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Name: "I Mailing Add .Legal Description: 'a7 .Depth ,Depth (feet) 0 1 2 3 4 SOIL LOG Soil Characteristics 144 �i6rjd / 94aJLZ F75 ef(!c= lZc1 Lots c; f 7o e kj � oy �e� 1� 1 7,--m d'�� 4F-iev 170 a- - -1 - 10 -�— Earl Ellis 688-2280 Tel. No. &OR -0 PLOT PLAN 11 T' 12 ,t j' PERC. TEST 13 V� „� �-2��ac4�za c�".QrE � i2sstix/�.r✓cC.� 14 15 / ��r%r�m o� C VI.- yy I © 15 Ground Water Encountered: Yes NoP'Uifzypv✓hat depth Proposed Installation: Seepage Pit- Drain Field ✓ Comments: Ayre--� e -,,c- --'31, i� '' �ae'y ���°-moi ��� �.'oAJ / A.- ,.-fid :X - Performed by: �C� �,� �T Date:�� �9�® . . ~ ^ MUNICIPALITY OF ANCHORAGE Department o( Health & Human Services 825 L Street, AnchorageAlaska 99501 343-4�f�� ON. - SITE WELL PERMIT ' Permit Number: 890180 Upgrade Date Issued: 08/25/89 Owner Name: HAROLD JURGENSEN Day Phone: Owner Address: 16207 OLD GLENN HWY^ 688^2385 EAGLE RIVER, AK 99567 Parcel Id: 4�, 292�22 Lot Legal: Subdivision: HENKING Lot: 4 Block: 1 Section: 30 Township: 151 Range: 1W Lot. Size 21344 (sq.ft, or acres) ' Max Bedrooms: This Permit: 0 Total Capacity: 3 WELL: Log must be submitted to Municipality o{ Anchorage !Myna rhnent o{ Health and Human Services within 30 days oK well compleiion^ ' WELL TO BE INSTALLED PER ENGINEERS ATTACHED DRAWIN8, PLEASE INDICATE WHEN EXISTING WELL WAS ABANDONED WHEN SUBMITTING THE WELL LOG" THIS PERMIT IS ISSUED FOR THE EXISTING 3 BEDROOM SINGLE FAMlLY HOME ONLY AND EXPIRES ON 12/31/89" I CERTIFY THAT: 1" I am {amiliar with the requirements |or onsite sewers and wells as set [orth by the Municipality o� Anchorage (MOA) and the State A Alaska" it. I will install the system in accordance with all MOA codes and regu1ations, and in compliance with the design criteria of this permit^ 3" I will adhere to all MOA and State of Alaska requirements for the set back distances {rom any, existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 0 bedrooms. I aIso understand that the capacity o� the total system is 3 bedrooms and any enlargement will require an additional permit, / Signed: �2 DATE: (Owner) HAROLD Issued By: DATE: / � 1 i 0 {-ANi K AI( AS BUILT SURVE4. /"% q % r I 3f_ n ^i .�4/trtil tl a ,,00,0�oe n X i � SF•.r[,( LI_ 4 6 / ST.*ru I / -- NEW WfLI I s' + JI "`ac ,j Sfcnc- 71 A ]7)NA 5r.4.44Z 8<OG 4Y rF L Q 0 X 63 /5)c 1O•X /7r /"% q © O I 3f_ ^i .�4/trtil tl ,,00,0�oe n � %1!S rOliycE LI_ 27- / WILL I / -- NEW WfLI I + JI "`ac ,j %IPL 71 A 5r.4.44Z 8<OG 4Y rF 1 fig! O ®��1 i A/ S Z� 2/' -A E 1 Cr de f.5• p°p °esaoee® a4q % '® e 49 N r °a fs I Go..,....rs5/o.vf.CS OfLG tpaP�°.am e•�aaape9 as p,® I a� �g ePP°Psoa a°eo. e•eee •o eee •• `� :p Louis A. Butera • f�� ®® z _,5-4r �6. 39S I 4eA aP CE -6736 � I I pop •••\V d')9 1 �r�, Pa�.. as.p 0•J��\� -- * , �L O G.0 En/.v ,y wY. I I Richard P. Hankins, hereby certify that I hove survoyed the following described property; UT//VK/VoAnchorage Records, laskaa7 encroachments exist except as indicated hereon, C �E 0'. ,4�q b It is the responsibility of the owner to determine the existence of �C'2�:' any eosements, covenants, or restrictions which do not appeor on u the recorded subdivision plat. Under no circumstances should 49I_" i.1 . any data hereon be used for construction or for establishing boundary or fence lines. 4Hu f 00 AO Qp e•• >i "ClIrf S S Ka, Xv a y %mow Dole: Drawn by: Nepoie0 by RICHARD R HANKINS REGISTERED PROFESSIONA{ LAND SURVEYOR Scale: Piot filing no: P.O. BOX 1105 • EAGLE RIVER,ALASKA /'/= 3vP-3637 PH. 694.2371 99577 t39• /G va Trrtifirbi3rilliug Ku) DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND d�4040 %iukG1-e r=✓J DEPTH OF WELL ADDRESS YO_ D .)'; Dx 0 Fcc % STATIC LEVEL OF WATER FT. JT L LEGAL DESCRIPTION/- a 1 'q t?C k / /7'ti +Jk,i'j-' DATE - Started Ended _ PERMIT NUMBER DRAW DOWN FT. GALS. PER HR /S"a 0 KIND OF CASING 4^ p O4 KIND OF FORMATION: From Ft. to Ft. W 4 1 `-d From Ft. to--Ft— o_Ft.FromFt. From J Ft. to r� Ft. C1'9")6 15 t I(.K `1 P From Ft. to Ft. From Ft. to Ft. �\ r? J 0 61`A0= % t'% '' From, Ft. to Ft. ___ From �~ Ft. to Ft. J '� �tr� 1 ��4J=� From - Ft. to_ Ft. From Ft. to _Ft. S_AAA) / 6 From Ft. to Ft. r� From Ft to Ft �`=�'� /__— o From Ft. (o—Ft----,-- Ft ---- From Ft. to -:I From_�Ft.to_Etj Ft. From Ft. to Ft. W 4 1 `-d From Ft. to--Ft— o_Ft.FromFt. Ft. to Ft. From-Ft. to-Ft.- oFt.From From From Ft. to Ft. From Ft. to Ft. ENVIRONMENTAL PROTECTION From Ft. to Ft. From - Ft. to-- Ft. From Ft. to Ft. From Ft. to Ft. --- From Ft. to—Ft.— oFt.FromFt. From-Ft. to Ft. _ From Ft. to --Ft. MISCL. INFORMATION: From ---Ft. to Ft- From Ft. to—Fl. -_ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MUNICIPALITY OF ANCHORAGE From FtD&j_QE_ff)S4TH & ENVIRONMENTAL PROTECTION From Ft. to Ft. O S1989 Ft From Ft. toJL - From Ft. R -K From Ft. to Ft. --- From Ft. to Ft. From Ft. to DRILLER'S NAME — • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-292-22 1. GENERAL INFORMATION Complete legal description HenkinS, Block 1, Lot 4 Location (site address) 16207 Old Glenn Hwy r R Expiration Date: qj 1 �2 - / -1 5 Current Property owner(s) Daniel and Kimberly Crowley Day phone _ Mailing address Real Estate Agent 133 W Canterbury Dr Wasilla, AK 99654 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well i] Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: Date: 5.1130201S COSA to be released to the engi eer unless otherwise requested by the engineer. COSA Fee $ 5a (o " Date of Payment .517116 Receipt Number /► Q (D l�QpT COSA# Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply _and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend an the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the Control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the ownerlisted above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 04/29/2015 I�'A � 6. DSD SIGNATURE " . .. r . """; System #1 Approved for bedrooms t etre P i ore System #2 Approved for bedrooms c�'•, CE System Disapproved itOtE55t_+i" Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 2— T unici it f Aorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible. for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheetr%'. 0 If more than 1 septic system is on the lot: COSA Checklist #_of? Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description:-Hen'k'1`M-,� lock 4 -,Lot 4 "ELIr DATA Well type Private If A, B, or C provide PWSID # Date completed 08/1989 Sanitary seal (Y/N) Y Total depth 81 ft. Cased to 81 ft. Date of test Static water level Well production FROM WELL LOG 08/1989 55 25 ft. 9.p -m. Parcel ID:051-292-22 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 04/29/2015 59 ft 4.2 g,p.m. WATER SAMPLE RESULTS: p Coliform Pe- colonies/100 mL Nitrate S 1 � mg/L Arsenic ug/L Date of sample: 04/29/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Steel Date installed Q7/29/2011 Tank size 1.000 gal Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YM) Y Depression over tankp (Y/N) For High water alarm (Y/N) N Date of pumping it ZD Pumper v L S I L,f n C. ABSORPTION FIELD DATA.. Date installed 05/31/1980 Soil rating (g.p.d./ft2 or felbdrm) 136 sgft/bdrm System type DeepTrenCh Length 41 ft. Width 4 ft. Gravel below pipe Total depth 9.1 ft. Eff. absorption area 410 fig Monitoring tube Y Depression over field N Date of adequacy test -04129/2015 Results (Pass/Fail) PASS For 3— bedrooms Fluid depth in absorption field before test .0 in. Water added 468 gal. New depth 10 in. Elapsed Time: 220 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No Absorption rate >= 450+ g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at in Datum Size in gallons Manhole/Access (Y/N) 'Pump off' level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements?,, E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots -100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line i 10+ B Id' f ndation 10+ Water Service line 10+ Curtain drain 50+ F. COMMENTS umg ou Surface water 100+ Wells on adjacent lots 100+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 04/29/2015 COSA canary sheet_2.6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. Municipality of Ancht fag. _ • Development Services Department sA Building Safety Division a On -Site Water and Wastewater Program SA E7 r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01;3.-292-22 COSA #� Expiration Date: 1. GENERAL INFORMATION Complete legal description Henkins. Blk3..Lt4 Location (site address) 16207 Old Glen Hwy, Eagle River Ak. 99577 Current Property owner(s) Jennifer E Stiner Day phone Mailing address P.O. Boxv7263� Eagle River Ak. ggsvv Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-823.8 Address P.O. Box 100237. Anchorage AK geSio Engineer's Printed Name Steven R. Pannone, P.E. Date I?z&tZ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water -levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ! Original Certificate Date: (Rev. 11/05) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Henkins BIk2. Lt4 Parcel ID: 052-2g2-22 A. WELL DATA Well type Private If A, B, or C provide PWSID #_ Date completed 8/28/lq8q Sanitary seal (Y/N) Y_ Total depth 8i ft. Cased to 8o' 61, ft. FROM WELL LOG Date of test 8/28/2080 Static water level sc ft. Well production 25 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 24, in. AT INSPECTION 6112/2022 5s ft. Coliform ALe colonies/100 mL Nitrate _�>19 7 mg//L Arsenic: *ICI-) ug/1 Date of sample: 4LA IZ Collected by:_Tnels B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Date installed 7/20/2o22 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) NIA Date of pumping 7/29/2022 Pumper New Tank Installed C. ABSORPTION FIELD DATA Date installed 5/11/108o Soil rating (g.p.d./ftz or felbdrm) 216 ft/bd System type Deep Trench Length 42 ft. Width A ft. Gravel below pipe 5 ft. Total depth g ft. Eff. absorption area 4�o ftp Monitoring tube Y Depression over field N Date of adequacy test 6/22/2012 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test i in. Water added46o gal. New depthi in. Elapsed Time: loo min. Final fluid depth z in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION "Pump on" level at Datum Size in gallons in. "Pump Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot aoo+ Absorption field on lot aoo+ Public sewer main 75+ Sewer /septic service line zS+ Animal containment areas —ioo+ Manhole/Access(Y/N) High water alarm level at Meets alarm On adjacent lots ioo+ On adjacent lots ioo+ Public sewer manhole/cleanout ioo+ Holding tank ioo+ Manure/animal excrete storage areas aoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line ;+ Absorption field s+ Water main io+ Water service line io+ Surface water ioo+ Wells on adjacent lots aoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io+ Building foundation io+ Water main io+ Water Service line ao+ Surface water aoo+ Driveway, parking/vehicle storage io+ Curtain drain co+ Wells on adjacent lots ioo+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and :"F d,- 'q. , review of Municipal records that the above systems are in n conformance with MOA COSA guidelines in effect on this date. • • ... •• %Steven R.Ponnonei Engineer's Printed Name Steven R. Pannone, P.E. •�jC '• No. ce 81 49 ° C2 � Date e2®co COSA Fee $ !�6) o 1 Date of Payment (-Oh S 11 a-1 Receipt Number f?c7 5�1 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 711 3r MUNICIPALITY OF ANCHORAGE Via,„! „ 4vCfli}t74,;, ° DEPARTMENT OF HEALTH & HUMAN SERVICES !'i,; ` _ Division of Environmental Services �p =% r On -Site Services Section 7996 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ' S _ , `I ) — �'Z ” HAA # � �'\S r—C 1. GENERAL INFORMATION Complete legal description fi -.tit %S �.Gr� 4'-s""' - ` if (311 _7 - Location Location (site address or directions) / c c"et' C /`-'I.�% /-/'- C' -� '4/1 �l'!3 '!(% Property owner �fi + j�. " 'J� L Day phone ,p`2 _ ��? `` Mailing address b x 7122 3 Eu,ki Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3'%/ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm1?;.>A,• wee—Sox vice t-- Phone -s Address P.O. Box 773294, Bade River, rAK 99577-3294 Engineer's signature 6. DHHS SIGNATURE __`L Approved for ���� bedrooms. M Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and theirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7 . 9 iaov voii Rack MnL n 1 10 Municipality of Anchorage rP,p��`4FRYaJHa DEPARTMENT OF HEALTH & HUMAN SERVICES_ Environmental Services Division 1998 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) ff ii Health Authority Approval Checklist pi Legal Description: e.�k 1e95 KrLei 13.E Parcel I.D.: CSS 1 2- A. WELL DATA Well type 'y it If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 5 Date completed Total depth Cased to `�� �Casing height (above ground) ,S Sanitary seal (Y/N) Yes Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 73- 73, 3 A V 9' Static water level S S Well production g.p.m. ¢S 3 9 -P.M. WATER SAMPLE RESULTS: Coliform Yfi Nitrate s'y`i 5� Other bacteria Date of sample: 3 — 3 —21Y Collected by: 'F_ B. SEPTIC/HOLDING TANK DATA Date installed I ?FO Tank size Number of Compartments )- Cleanouts (Y/N) %5 (1) Foundation cleanout ON) %e S Depression (Y/N) c' High water alarm (Y/N) /16) Date of Pumping '3--3-W6 C. ABSORPTION FIELD DATA Pumper Date installed % ���� Soil rating (g.p.d./ft2 or ft2/bdrm) /36 �r `�, System type System // Length q% s Width ' Gravel thickness below pipe S Total depth i Effective absorption area ``l /0 Monitoring Tube present (Y1N)_A_L Depression over field (Y/N) I/E7 Date of adequacy test 3--3'- qg Results (Pass/Fail) mss For a bedrooms Fluid depth in absorption field before test (in.); Immediately after g2Sgal. water added (in.): �� Fluid depth -,S " (ins) Minutes later: �Absorption rate = .4-115 g.p.d. Peroxide treatment (past 12 months) (Y/N) IV,1,9 If yes, give date /0 72-026 (Rev. 3/96)' D. LIFT STATION Date installed / 14 Manhole/Access (Y/N) High water alarm J E. SEPARATION DISTANCES Size i on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot I q1 On adjacent lots �qc i Absorption field on lot 5S- On adjacent lots Jor/ Public sewer main zt� Public sewer manhole/cleanout lf,1,4 Sewer /septic service line 6� S Lift station 1VX SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 93' Property line Z e� Absorption field .57 r Water main/service line I c7S Surface water/drainage N4 Wells on adjacent lots +fe)" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line % 7 Building foundation F d Water main/service line +/0 Surface water ,V,4 -"` 14, Driveway, parking/vehicle storage area t fv Curtain drain N'/i Wells on adjacent lots -f /o« ", F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records' that! the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name yr� Date _G T #. HAA Fee $ X) 0 r c) 0 Date of Payment Receipt Number 5 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .r' MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# Aola_ QQ HAA# tAnS-111D 11a?S 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Henkins Sub., Lot 4 Block 1 T15N, R1W, Sec. 30 Location (address or directions) 16207 Old Glenn Hwy. Chugiak Ak 99567 (b) Property owner Mr. & Mrs . Jurgensen Telephone: (home) 688-2385 Business Mailing Address 16207 Old Glenn Hwy Chugiak Ak. 99567 (c) Lending Institution 4lk_ Telephone Mailing Address (d) Real Estate Company and Agent Great land Realty/Caroline Stre ano-Thomas Address 11411 Old Glenn Hwy. Eagle River Ak 99577 Telephone 6y4— (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-FamilyXI 3. WATER SUPPLY Individual WeIIKI Number of bedrooms 3 Commuoity ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 0 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmEagle River Engineering Srv. Telephone 694– Address P.O. Box 773294 Eagle River Ak 99577 Date y-5- 9' q 4 )pl, 1 a VOJ ' ;Enginedr's'Seal 6. DHHS APPROVAL Approved for 3 bsdrooms by Jot1N 5M (n� Date Approved _ X _—Disapproved Conditional Terms of Conditional Approval _k SeE P rrA-e;,H� tMEW10 TM AALc . ?Ar"6S Coc�ic �tica,� CAUTIONY The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY NCHORVEINICIPALITY OF ANCHORAGEMOA DEPT. & ANCHORAGE(MOA) ENVIRONME 4 ECTION Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 Ucp �g18,9 343-4744 Legal Description: Ne"'H�yl s'•� L"` elj�Kl j /Sr .✓ l / L✓ .rte3 0 �`. t l t.{..i� ,/_ Sl.� (OMt hVCLl/ RECEIVED A. WELL DATA a Well Classification If A, B, C, D.E.C. Approved (Y/N) pfd Well Log Present (Y/N)Date Completed Yield -2t di°n+ fLos Total Depth 2/� Cased to ��,6,, Depth of Grouting "�/� Static Water Level rs Pump Set At Casing Height Above Ground -2 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / `/l On Adjoining Lots''1470 To Nearest Edge of Absorption Field on Lot /S"S' ; On Adjoining Lots 100 To Nearest Public Sewer Line NIA To Nearest Public Sewer Cleanout/Manhole ^o/A i To Nearest Sewer Service Line on Lot =S Water Sample Collected byFws �^^ee, ; Date T lis Water Sample Test Results �O�iFprm = (l pV, tra fe = 3,7 —TA Comments /1/77%a)e - 3, S- —3/� f>/mP i v e l� �ar�y✓e r/.� cr 6a wa�l��e �( �`a iii o�-t Ca �l� . B. SEPTIC/HOLDING TANK DATA Date Installed 19" Size /Overs No. of Compartments �Z Standpipes (Y/N) Ik Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) % Depression over Tank (Y/N) Date Last Pumped 4/d'5 Zr-rj.4ef Pumping/Maintenance Contact on File (Y/N) ;for r✓�� Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) "_/� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well //J To Building Foundation To Property Line ao To Disposal Field—� i To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 31/ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed /lPo Length of Field 4sl f Width of Field `f8 Depth of Field 9/ Gravel Bed Thickness S� Tp -e. e, 11, Square Feet of Absortion Area ylo Statndpipes Present (Y/N) Y Depression over Field (Y/N) Date of Last Adequacy Test s Results of Last Adequacy Test Sa 7t, J' 7 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well �`� To Property Line To Building Foundation To Existing or Abandoned System on Lot !!5s� �o �' ; On Adjoining Lots To Water Main/Service Line '`�� To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines,in:effe.ct on th@date of this inspection. r� - F� Signed A/C Eagle River Engineering Services fr Company P. 0 Box 778294 Engineer's Seal Eagle River, AK 99577 � Date ( a '+ MOA No. ST `a16 4, ( FP Receipt No. Receipt No. Date of Payment Waiver Fee: $ Amount: $ 4 10.L�rJ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 TO ALL PARTIES CONCERNED: All concerned panties ar-e advised that the=ubJect Health Authority Approval HA-cii( 328' for Lot 41 E,lock: i Hen[ -.:ins Subdivision is being appr-oved based on the fact that a new we]1 was con=trticted to replace an existing well whi,=h was tested and confirmed to have a nitrate concentration of 9.7 mg/l. The new wel l has been tested at 3.5 mg/1 nitrate. Since the new wel l is producing fr-om the sa-,rie aquifer• as the old well a there is a possibility that nitrate concentrations in the new well ma`.i' increase abo`e 3.5 mg/1``h-.� The EPA has established 10mg/1 as the m maximuconcentrkiort fc- nitrate_ in drinECinq water-. AU -4 J_�hn Smith. P.E. J Pr-ogram Manager, On—site Services MUNICIPALITY NCHOIuNICIPALITY OF ANCHORAGE (MOA) DEPT.ENVI ONME t ECTIOIV Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 vcP I9P.9 343-4744 L Legal Description: IL%"'k�yr Su�,lr it z/ T is / Iw fe . 30 �L� uo'ulor>u 4J - A. WELL DATA (d RECEIVED Well Classification If A, B, C, D.E.C. Approved (Y//N) Well Log Present (Y/N) Date Completed F19-'5 Yield -2S Total Depth Cased to Depth of Grouting AVI.4 Pump Set At Static Water Level .S -S ' Casing Height Above Ground :2-" Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / `'II Sanitary Seal on Casing (Y/N) _-Z Depression Around Wellhead (Y/N) On Adjoining Lots""/00 To Nearest Edge of Absorption Field on Lot /SS' ; On Adjoining Lots To Nearest Public Sewer LineOJ To Nearest Sewer Service Line on Lot Water Sample Collected by F^'S'^'eG` ; Date 30 _ To Nearest Public Sewer Cleanout/Manhole ^'IA eS– Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed y5&1�0 Size /DVDs No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) Date Last Pumped � � 1. -rr4cf Pumping/Maintenance Contact on File (Y/N) ;for ^'/u Holding Tank High -Water Alarm (Y/N) In/A" Temporary Holding Tank Permit (Y/N) A% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation To Property Line moo' To Disposal Field—� l To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata J36 #Ieaz Type of System Design Date Installed ltp__o Length of Field 4'� J "en., 9 � Width of Field Depth of Field Gravel Bed Thickness S Square Feet of Absortion Area Z11a Statndpipes Present (Y/N) Y Depression over Field (Y/N) /7/ Date of Last Adequacy Test Results of Last Adequacy Test S4 �`'r'`�� 7i'51 ��s"" d "'"� 1115�'el- SEPARATION DISTANCE FROM ABSORPTION FIELD: / To Water -Supply Well J e To Property Line To Building Foundation �6 Lot Esy, Zo �� ; On Adjoining Lots To Cutback (if present) To Water Main/Service Line f/o To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area _z1 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments To Existing or Abandoned System on 7''9z� Z o' Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in,*effec't on thgjdate of this t inspection. 6 S t lo c - X Signed Engle River Engineering Services _ .,. Company �A•°� =` "` Engineer's Seal Date Eagle River, AK 99577 G. �.,,....•• "' MOA No.00 Receipt No. 3� Receipt No. _ Date of Payment k k Waiver Fee: $ Amount: $ 11C fir✓ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 1. 41 SEWAGE DISPOSAL SYSTEM - APPLICATION 6 PERMIT oe Nagar of Applicantg•Ajerx Mailing Address 5 Ph. #.. Residence Address �,� Location of Installation 4, 7,_ /I Legal Description " � Application to Install: Septic tank Seepage pit Drain field., Other�� To Serve the Following Facility nn Financed Through To be Installed by fie Percolation Test Results Anticipated Date of Completion BELOW TO BE FIL ED OUT BY HEALTH DEPARTMENT5'j��- 3'Ifa 5�F III This is to serve as;z.8 permit to install a as described by�5�`' `� ' tr SizAf unit to be sex+�vc�d�' i f .� tic tank size Type Seepage Area Type DIAGRAM OF SYSTEM DISTANCES: % i ' O i I rcaw,fcr.7 li FTlfl rr �'y. -�r ti C h �j e ell I • , r? ! f { \IV�e 0 r� Hea h Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance ycith said code. INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM Name `��,, /L'A� ';c�A/ Mailing Address i ,� i, "/) (i cr:'.Ph.# Location Legal Description SEPTIC TANK: Distance from well `)Y Material �f l=L Number of compartments�� Liquid capacity (�(>' gallons. Inside length.�wInside width ! Liquid depth SEEPAGE SYSTEM: Seepage Pit: Number of pits./ Outside diameter or width , length S , depth, lining material -i Distance from well, building foundation 61,}I,, nearest lot line -;LL Total effective absorption area (wall area) ,5 sq, ft. TILE DRAIN FIELD: Distance from well , foundation , nearest lot line Total length of lines Number of lines Distance between lines Trench width in. Total effective absorption area sq. ft. Length of each line Depth: Top of tile to finish grade Depth of filter material beneath tile_ in. Above tile WELL: Type %`1 (lry;, depth �,(� `, distance from building foundation �/ / nearest s lot line '�Ll, nearest sewer line )-4 ,septic tank �seepage system cesspoolother sources DISTANCES: A -n _ �-), i- nTArRAM nr CYCTFM / 9 DATE APPROVED Health Authority